Preoperative diagnosis of a pulmonary artery sarcoma

Pulmonary Artery Sarcoma Diagnosed Using an Endovascular Catheter Forceps Biopsy

We herein report a case of pulmonary artery sarcoma (PAS) in a 64-year-old woman. She was admitted to our hospital because of massive genital bleeding from endometrial cancer. Contrast-enhanced computed tomography (CT) revealed a left pulmonary artery mass and deep vein thrombosis. She underwent anticoagulant therapy for one year. However, the mass lesion gradually expanded. ¹⁸F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT showed a positive uptake of FDG by the mass. An endovascular catheter biopsy was performed for the differentiation of endometrial cancer metastasis or primary sarcoma. The biopsy specimen tissue comprised spindle-shaped cells. Thus, the patient was diagnosed with PAS.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis

Pulmonary artery sarcoma (PAS) is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy. Early diagnosis and radical surgical resection offer the only chance for survival. However, making a preoperative histopathological diagnosis is quite difficult. We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism. After confirming a definitive diagnosis using a catheter suction biopsy, we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass. Eighteen months after surgery, no recurrence was observed.

Pulmonary MR angiography techniques and applications

This article discusses the role of magnetic resonance angiography (MRA) in evaluating the pulmonary arterial system. For depiction of pulmonary arterial anatomy and morphology, MRA techniques are compared with CT angiography and digital subtraction x-ray angiography. Perfusion, flow, and function are emphasized, as the integrated MR examination offers a comprehensive assessment of vascular morphology and function. Advances in MR technology that improve spatial and temporal resolution and compensate for potential artifacts are reviewed as they pertain to pulmonary MRA. Current and emerging gadolinium contrast-enhanced and non-contrast-enhanced MRA techniques are discussed. The role of pulmonary MRA, clinical protocols, imaging findings, and interpretation pitfalls are reviewed for clinical indications.

Primary angiosarcoma of the pulmonary arteries: dynamic contrast-enhanced MRI

PURPOSE

Our goal was to assess the MR appearance and histologic correlation of primary pulmonary artery angiosarcoma.

METHOD

Four patients with tumorous masses in the pulmonary arteries were evaluated by dynamic contrast-enhanced MRI using T1- and T2-weighted SE images, GE images, as well as coronal 3D MRA in breath-hold technique. The percentage of tumor enhancement was determined by measuring regions of interest before and after Gd-DTPA administration on the 2D multiplanar spoiled GRE images.

RESULTS

All four masses showed some contrast enhancement on the dynamically acquired GRE images. The degree of contrast enhancement correlated with the degree of tumor differentiation, content of myxoid matrix, and associated thrombus. Contrast-enhanced 3D MRA was useful for preoperative delineation of the peripheral pulmonary arteries to the subsegmental order.

CONCLUSION

Dynamic contrast-enhanced 3D MRA of the pulmonary arteries can be used to delineate pulmonary arterial angiosarcomas preoperatively. Considerable variability of contrast agent uptake reflects the wide histologic behavior of these masses in differentiation from central pulmonary embolism.

Pulmonary artery sarcomas: a review of clinical and radiologic features

Primary pulmonary artery sarcomas are rare tumors that are frequently misdiagnosed as chronic pulmonary emboli. We present classic imaging findings and review data from 136 previously reported sarcomas. We believe that the imaging findings can be quite specific, especially when the disease is advanced. Despite a recent increase in antemortem diagnosis, the prognosis remains poor. Surgery prolongs survival time and is potentially curative. Experience with adjuvant chemotherapy and radiotherapy is limited.